| Pdg, Pa | |
|
18230 Zane St Nw Elk River MN 55330-4501 | |
| (763) 201-1313 | |
| (763) 201-1314 |
| Full Name | Pdg, Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 18230 Zane St Nw, Elk River, Minnesota |
| Authorized Official Name and Position | John Gulon (PRESIDENT) |
| Authorized Official Contact | 6516330500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pdg, Pa 2200 County Road C W 2210 Roseville MN 55113-2550 Ph: (651) 746-2815 | Pdg, Pa 18230 Zane St Nw Elk River MN 55330-4501 Ph: (763) 201-1313 |
| NPI Number | 1285170464 |
|---|---|
| Provider Enumeration Date | 01/12/2017 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285170464 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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